Autopsy finds fluid build-up in organs caused death of woman with dead foetus

-had been prescribed Cytotec

An autopsy has found that a fluid build-up in the organs was the cause of death of Carol Chuniram, who died earlier this month at the Diamond Diagnostic Centre after an unsuccessful surgery to remove a foetus that had died in her womb.

In addition, Chuniram’s family says she was also prescribed the drug Cytotec (misoprostol), which has contributed to a number of maternal deaths over the years.

Stabroek News was shown the death certificate of Chuniram, 39, of Cinema Street, Diamond, East Bank Demerara, which listed several factors that indicated that she died as a result of a fluid buildup in her organs, inclusive of her lungs and kidneys.

Carol Chuniram
Carol Chuniram

The factors listed included acute lung distress, severe edema, congestion of the airways and kidney and adrenal glands shock.

Additionally, Stabroek News was able to confirm that Chuniram had been prescribed Cytotec by her doctor as a means of inducing labour.

While Cytotec is clinically prescribed for the prevention of gastric ulcers associated with the use of nonsteroidal anti-inflammatory drugs, the use of the drug has been associated with maternal deaths across the world as it is has been noted to have serious adverse effects. Some of these effects include maternal or foetal death; rupture or perforation requiring uterine surgical repair; severe vaginal bleeding; retained placenta and pelvic pain.

Despite this, however, the drug continues to be available to pregnant women and women of child-bearing age.

Chuniram’s relatives ultimately blame the treating doctor and the nurses at the Diamond hospital for the woman’s death.

Recounting the series of events that led to his wife requiring the surgery, Ramesh Chuniram told Stabroek News that his spouse, who was 24 weeks pregnant, had requested an ultrasound at the hospital.

The family believes that it was after the ultrasound was done that medical personnel there realised that something was wrong with the baby. The woman was subsequently instructed to undergo a second ultrasound at the Woodlands Hospital in the city and she took the results back to the Diamond hospital.

It was after the ultrasound results were presented to the doctor at Diamond that the couple was informed that the foetus had stopped showing any signs of development somewhere around the 18th week, implying that the baby had died.

Ramesh said that while they were devastated by the news, he suddenly became concerned about the possible health risks his wife would face, since she had been carrying a dead foetus in her womb for some time.

However, he explained that the doctor assured him that his wife would be okay. With a prescription supplied by the doctor, Ramesh was then instructed to purchase two Cytotec tablets from the pharmacy. The tablets, he said, were to help his wife “bring down” the dead foetus.

“He tell she to take the tablets and when she start feel pain or when she pass out the baby, he gon look after her and clean her up,” the man related.

The widower said several days passed without any indication of the pills working, which prompted Carol to return to the hospital, where she was once again given a prescription for the Cytotec. He stated that although the doctor assured him that his wife would be fine, he remained skeptical.

“The Sunday we go out there and that’s when she tell me she feeling a numbness in she leg so me go to the hospital and tell he (the doctor) that this girl parents wan take she to Georgetown,” he said.

The doctor reportedly responded by pointing out his unwillingness to treat Carol if she was sent back to the Diamond hospital. “If he (the doctor) know he couldn’t ah properly look after she, he shoulda send she to Georgetown Hospital,” the man lamented.

But while relatives claimed they encouraged the woman to visit the Georgetown Hospital, Carol opted to continue her treatment at the Diamond Hospital as she was confident that her life was in capable hands.

“After he [the doctor] start tell she things, she decided to stay at Diamond. Me and she end up rowing and she said she believe in he and she put she life in he hand,” the man lamented.

In the dark

On the day of the surgery, Ramesh recalled hearing the screams of his wife emanating from the operating room, only to be informed of the woman’s death shortly after.

“I hear she holla two times, one time hard and the other time more easy like she cyan mek it no mo…,”he said.

Another relative, who was also present at the hospital at the time, said that there was evidence that would indicate that Chuniram suffered extensive bleeding as there were large amounts of blood on the floor and the bed after her body was moved.

Further, they accused the Ministry of Public Health of keeping them in the dark over the status of the investigation of the woman’s death.

Ramesh related that there has been no communication from the Ministry apart from the initial visit shortly after his wife died.

“Ministry people come one time on the 11 and they never came back. They tek lil information and they say they gon get in contact with me, since then I didn’t hear back anything from them. None body ain said anything back, none body ain follow up anything, it just left like that. So we wan know wah really going on,” the man lamented.

However, in response to these claims, Minister of Public Health Dr. George Norton stated that investigations of such a nature often take time as there is a specific procedure that has to be followed before a report is submitted.

When reminded that this process is supposed to only take 14 days, the Minister indicated that the preparation of the report depends on the availability of the information.

He further said that he has not yet seen a report from the Medical Council.

Meanwhile, although there have been several debates over the use of Cytotec because of its harmful side effects and its contribution to maternal deaths locally, some medical practitioners continue to use the drug to induce labour.

Last October, Liloutie Ashantie Ramlall Khamis, 33, of Bee Hive, died as a result of suffering hypovolemic shock and rupture of the spleen due to a Caesarean section at the Davis Memorial Hospital.

The woman’s sister, Parbattie Ramlall, had told Stabroek News that a midwife examined her sister and said she was not in labour and called the doctor. According to Ramlall, the doctor asked the midwife to give her sister an enema and wait for him to arrive. On his arrival, Ramlall claimed, the doctor inserted a tablet into the woman and left. About an hour later, the woman started to complain of severe pain in her back and abdomen. Soon after, she began bleeding and was rushed to the theatre.

It was while doctors attempted to locate the source of the bleeding that the woman’s spleen was reportedly ruptured. “They had to remove the spleen. When they remove the spleen, she was still bleeding and she went into cardiac arrest and her heart stopped,” the sister said.

Ramlall, who is a trained nursing assistant, is convinced that Khamis was given Cytotec to induce labour. She noted that a patient who has been given Cytotec needs to be closely monitored.

Back in 2013, the use of Cytotec to induce labour for Luan Rodney, was also listed as a possible factor in her death at the Georgetown Public Hospital.

Luan Rodney’s husband, Nigel, had told Stabroek News that he was informed that she had a Cytotec pill inserted into her to bring on labour since she was long past her due date.

She was due to deliver by May 22, 2013 and the pill was inserted on the night of June 3, 2013. She died the following morning at the Georgetown Hospital from what doctors have described as a ruptured uterus. Her baby, a girl, also died.

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